Combined systemic immune-inflammatory index and prognostic nutritional index predicts prognosis in patients with renal cell carcinoma undergoing laparoscopic nephrectomy

doi:10.3877/cma.j.issn.1674-3253.2024.03.005

Abstract

Abstract:

Objective

To investigate the prognostic value of a combination of systemic immune-inflammatory index (SII) and prognostic nutrition index (PNI) in patients with renal cell carcinoma (RCC) undergoing laparoscopic nephrectomy.

Methods

The clinical data of 633 cases with RCC undergoing laparoscopic nephrectomy in the First Hospital of Shanxi Medical University from January 2013 to December 2021 were retrospectively analyzed. SII and PNI were calculated based on peripheral blood cell count and serum albumin, the optimal cut-off values were determined using X-tile software, and SII-PNI scores were constructed. All patients were divided into three groups according to SII-PNI scores, and the correlation of clinicopathological features between the groups was analyzed. Kaplan-Meier curve was used to analyze the effects of SII-PNI score on overall survival (OS) and recurrence-free survival (RFS) of patients with RCC. Univariate and multivariate Cox regression analysis was used to determine prognostic factors. Receiver operating characteristic (ROC) curve was used to evaluate the prognostic efficacy of each indicator.

Results

A total of 633 patients were enrolled. The results showed that SII-PNI score was significantly correlated with age, smoking history, diabetes history, pT stage, Fuhrman grade, surgical method and tumor size (all P< 0.05). The 3-year OS of patients with SII-PNI scores of 0, 1, and 2 was 97.0%, 89.5%, and 57.1%, and the 3-year RFS was 95.1%, 90.8%, and 78.6%, respectively. Kaplan-Meier curve showed patients with low SII-PNI score had significantly better OS and RFS than those with high SII-PNI score (P<0.001). Univariate and multivariate Cox analysis further showed that SII-PNI score was an independent prognostic indicator of OS (P<0.001) and RFS (P<0.001), and was more predictive than SII and PNI alone.

Conclusion

Preoperative SII-PNI score can be used as an independent prognostic indicator for patients with RCC after laparoscopic nephrectomy.

Key words: Systemic immune-inflammatory index, Prognostic nutritional index, Tumor microenvironment, Renal cell carcinoma, Laparoscopy, Nephrectomy, Prognosis

Huiyu Zhou, Dingyang Lyu, Weibing Shuang. Combined systemic immune-inflammatory index and prognostic nutritional index predicts prognosis in patients with renal cell carcinoma undergoing laparoscopic nephrectomy[J]. Chinese Journal of Endourology(Electronic Edition), 2024, 18(03): 225-231.

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References 28

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临床病理特征	SII-PNI评分			P值
临床病理特征	0分(n=529)	1分(n=76)	2分(n=28)	P值
性别[例(%)]				0.103
男	336(63.5)	47(61.8)	22(78.6)
女	193(36.5)	29(38.2)	06(21.4)
年龄[例(%)]				0.024
≤65岁	408(77.1)	49(64.5)	18(64.3)
> 65岁	121(22.9)	27(35.5)	10(35.7)
BMI[kg/m²，(±s)]	25.04±3.25	24.84±4.39	24.29±2.74	0.402
吸烟史[例(%)]				0.043
无	396(74.9)	57(75.0)	15(53.6)
有	133(25.1)	19(25.0)	13(46.4)
糖尿病史[例(%)]				0.046
无	451(85.3)	63(82.9)	19(67.9)
有	78(14.7)	13(17.1)	09(32.1)
高血压病史[例(%)]				0.696
无	321(60.7)	44(57.9)	15(53.6)
有	208(39.3)	32(42.1)	13(46.4)
心血管病史[例(%)]				0.944
无	484(91.5)	69(90.8)	26(92.9)
有	45(8.5)	7(9.2)	2(7.1)
病理类型[例(%)]				0.790
透明细胞癌	488(92.2)	69(90.8)	25(89.3)
非透明细胞癌	41(7.8)	7(9.2)	03(10.7)
pT分期[例(%)]				<0.0010
T₁	480(90.7)	60(78.9)	19(67.9)
T₂	42(7.9)	09(11.8)	04(14.3)
T₃	05(0.9)	5(6.6)	05(17.9)
T₄	02(0.4)	2(2.6)	00(0.0)
Fuhrman分级[例(%)]				<0.0010
1	096(18.1)	08(10.5)	03(10.7)
2	333(62.9)	36(47.4)	12(42.9)
3	086(16.3)	26(34.2)	11(39.3)
4	14(2.6)	6(7.9)	2(7.1)
手术方式[例(%)]				0.007
肾部分切除	202(38.2)	20(26.3)	04(14.3)
肾根治性切除	327(61.8)	56(73.7)	24(85.7)
肿瘤大小[cm，(±s)]	4.1±2.1	5.2±2.9	5.5±2.9	<0.0010

临床病理特征	SII-PNI评分			P值
临床病理特征	0分(n=529)	1分(n=76)	2分(n=28)	P值
性别[例(%)]				0.103
男	336(63.5)	47(61.8)	22(78.6)
女	193(36.5)	29(38.2)	06(21.4)
年龄[例(%)]				0.024
≤65岁	408(77.1)	49(64.5)	18(64.3)
> 65岁	121(22.9)	27(35.5)	10(35.7)
BMI[kg/m²，(±s)]	25.04±3.25	24.84±4.39	24.29±2.74	0.402
吸烟史[例(%)]				0.043
无	396(74.9)	57(75.0)	15(53.6)
有	133(25.1)	19(25.0)	13(46.4)
糖尿病史[例(%)]				0.046
无	451(85.3)	63(82.9)	19(67.9)
有	78(14.7)	13(17.1)	09(32.1)
高血压病史[例(%)]				0.696
无	321(60.7)	44(57.9)	15(53.6)
有	208(39.3)	32(42.1)	13(46.4)
心血管病史[例(%)]				0.944
无	484(91.5)	69(90.8)	26(92.9)
有	45(8.5)	7(9.2)	2(7.1)
病理类型[例(%)]				0.790
透明细胞癌	488(92.2)	69(90.8)	25(89.3)
非透明细胞癌	41(7.8)	7(9.2)	03(10.7)
pT分期[例(%)]				<0.0010
T₁	480(90.7)	60(78.9)	19(67.9)
T₂	42(7.9)	09(11.8)	04(14.3)
T₃	05(0.9)	5(6.6)	05(17.9)
T₄	02(0.4)	2(2.6)	00(0.0)
Fuhrman分级[例(%)]				<0.0010
1	096(18.1)	08(10.5)	03(10.7)
2	333(62.9)	36(47.4)	12(42.9)
3	086(16.3)	26(34.2)	11(39.3)
4	14(2.6)	6(7.9)	2(7.1)
手术方式[例(%)]				0.007
肾部分切除	202(38.2)	20(26.3)	04(14.3)
肾根治性切除	327(61.8)	56(73.7)	24(85.7)
肿瘤大小[cm，(±s)]	4.1±2.1	5.2±2.9	5.5±2.9	<0.0010

变量	总生存期单因素分析		无复发生存期的单因素分析
变量	HR(95%CI)	P值	HR(95%CI)	P值
性别(男vs女)	1.983(0.982～4.004)	0.056	1.438(0.773～2.673)	0.251
年龄(岁)(≤65 vs >65)	0.539(0.295～0.985)	0.045	0.685(0.377～1.245)	0.214
BMI	0.922(0.834～1.019)	0.112	0.925(0.840～1.019)	0.114
吸烟史(无vs有)	0.307(0.171～0.552)	<0.0010	0.491(0.277～0.870)	0.015
糖尿病史(无vs有)	0.407(0.216～0.765)	0.005	0.560(0.292～1.075)	0.081
高血压病史(无vs有)	0.942(0.519～1.711)	0.844	0.933(0.527～1.650)	0.810
心血管病史(无vs有)	1.370(0.425～4.420)	0.599	0.849(0.337～2.143)	0.730
病理类型(透明细胞癌vs非透明细胞癌)	0.332(0.154～0.713)	0.005	0.525(0.223～1.234)	0.140
pT分期		<0.0010		<0.0010
T₁	1		1
T₂	4.767(2.288～9.930)	<0.0010	4.457(2.231～8.903)	<0.0010
T₃	12.196(5.275～28.200)	<0.0010	05.476(1.927～15.558)	0.001
T₄	09.984(2.319～42.975)	0.002	12.408(3.671～41.940)	<0.0010
Fuhrman分级		<0.0010		<0.0010
1	1		1
2	1.508(0.505～4.504)	0.462	1.537(0.582～4.057)	0.385
3	05.288(1.768～15.817)	0.003	3.075(1.091～8.665)	0.034
4	13.368(3.876～46.106)	<0.0010	12.109(3.925～37.358)	<0.0010
手术方式(部分切除vs根治性切除)	0.216(0.085～0.547)	0.001	0.287(0.129～0.638)	0.002
肿瘤大小(cm)	1.331(1.218～1.454)	<0.0010	1.357(1.247～1.477)	<0.0010
NLR(≤3.0 vs >3.0)	0.162(0.090～0.291)	<0.0010	0.314(0.174～0.566)	<0.0010
PLR(≤200.6 vs >200.6)	0.137(0.075～0.252)	<0.0010	0.225(0.118～0.427)	<0.0010
SII(≤801.6 vs >801.6)	0.103(0.057～0.184)	<0.0010	0.291(0.154～0.550)	<0.0010
PNI(≤44.4 vs >44.4)	10.332(5.674～18.815)	<0.0010	3.715(1.924～7.175)	<0.0010
SII-PNI评分		<0.0010		<0.0010
0	1		1
1	3.318(1.451～7.587)	0.004	2.245(1.070～4.711)	0.032
2	24.862(12.851～48.100)	<0.0010	6.330(2.897～13.830)	<0.0010

变量	总生存期单因素分析		无复发生存期的单因素分析
变量	HR(95%CI)	P值	HR(95%CI)	P值
性别(男vs女)	1.983(0.982～4.004)	0.056	1.438(0.773～2.673)	0.251
年龄(岁)(≤65 vs >65)	0.539(0.295～0.985)	0.045	0.685(0.377～1.245)	0.214
BMI	0.922(0.834～1.019)	0.112	0.925(0.840～1.019)	0.114
吸烟史(无vs有)	0.307(0.171～0.552)	<0.0010	0.491(0.277～0.870)	0.015
糖尿病史(无vs有)	0.407(0.216～0.765)	0.005	0.560(0.292～1.075)	0.081
高血压病史(无vs有)	0.942(0.519～1.711)	0.844	0.933(0.527～1.650)	0.810
心血管病史(无vs有)	1.370(0.425～4.420)	0.599	0.849(0.337～2.143)	0.730
病理类型(透明细胞癌vs非透明细胞癌)	0.332(0.154～0.713)	0.005	0.525(0.223～1.234)	0.140
pT分期		<0.0010		<0.0010
T₁	1		1
T₂	4.767(2.288～9.930)	<0.0010	4.457(2.231～8.903)	<0.0010
T₃	12.196(5.275～28.200)	<0.0010	05.476(1.927～15.558)	0.001
T₄	09.984(2.319～42.975)	0.002	12.408(3.671～41.940)	<0.0010
Fuhrman分级		<0.0010		<0.0010
1	1		1
2	1.508(0.505～4.504)	0.462	1.537(0.582～4.057)	0.385
3	05.288(1.768～15.817)	0.003	3.075(1.091～8.665)	0.034
4	13.368(3.876～46.106)	<0.0010	12.109(3.925～37.358)	<0.0010
手术方式(部分切除vs根治性切除)	0.216(0.085～0.547)	0.001	0.287(0.129～0.638)	0.002
肿瘤大小(cm)	1.331(1.218～1.454)	<0.0010	1.357(1.247～1.477)	<0.0010
NLR(≤3.0 vs >3.0)	0.162(0.090～0.291)	<0.0010	0.314(0.174～0.566)	<0.0010
PLR(≤200.6 vs >200.6)	0.137(0.075～0.252)	<0.0010	0.225(0.118～0.427)	<0.0010
SII(≤801.6 vs >801.6)	0.103(0.057～0.184)	<0.0010	0.291(0.154～0.550)	<0.0010
PNI(≤44.4 vs >44.4)	10.332(5.674～18.815)	<0.0010	3.715(1.924～7.175)	<0.0010
SII-PNI评分		<0.0010		<0.0010
0	1		1
1	3.318(1.451～7.587)	0.004	2.245(1.070～4.711)	0.032
2	24.862(12.851～48.100)	<0.0010	6.330(2.897～13.830)	<0.0010

变量	总生存期多因素分析		无复发生存期多因素分析
变量	HR(95%CI)	P值	HR(95%CI)	P值
性别(男vs女)
年龄(岁)(≤65 vs >65)
BMI
吸烟史(无vs有)	0.363(0.190～0.697)	0.002
糖尿病史(无vs有)	0.435(0.215～0.882)	0.021
高血压病史(无vs有)
心血管病史(无vs有)
病理类型(透明细胞癌vs非透明细胞癌)	0.423(0.185～0.965)	0.041
pT分期
T₁
T₂
T₃
T₄
Fuhrman分级		0.005
1	1
2	1.842(0.604～5.621)	0.283
3	2.821(0.900～8.843)	0.075
4	8.452(2.298～31.089)	0.001
手术方式(部分vs根治)
肿瘤大小(cm)	1.222(1.094～1.365)	<0.001	1.325(1.213～1.447)	<0.001
NLR(≤3.0 vs >3.0)
PLR(≤200.6 vs >200.6)
SII(≤801.6 vs >801.6)
PNI(≤44.4 vs >44.4)
SII-PNI评分		<0.001		<0.001
0	1		1
1	2.497(1.061～5.880)	0.036	1.574(0.730～3.397)	0.247
2	13.534(6.810～26.899)	<0.001	4.663(2.107～10.322)	<0.001

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